MEDICARE: DR. BRADLEY ALAN ASTLEFORD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5949	KS

General Provider Information

NPI Number	:	1144243528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY ALAN ASTLEFORD D.D.S.

Provider Business Mailing Address
First Line	:	915 CLUB VIEW DR
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2937
Country	:	US
Telephone Number	:	620-225-6005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 CENTRAL AVE
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-6206
Country	:	US
Telephone Number	:	620-225-5154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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